Provider Demographics
NPI:1396097929
Name:ST CHARLES IMAGING CENTER
Entity type:Organization
Organization Name:ST CHARLES IMAGING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:C
Authorized Official - Last Name:SPAYDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-379-2322
Mailing Address - Street 1:558 ST CHARLES DR
Mailing Address - Street 2:111
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-3903
Mailing Address - Country:US
Mailing Address - Phone:805-230-2700
Mailing Address - Fax:805-230-2750
Practice Address - Street 1:558 ST CHARLES DR
Practice Address - Street 2:111
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-3903
Practice Address - Country:US
Practice Address - Phone:805-230-2700
Practice Address - Fax:805-230-2750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-05
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)